临床指南的预期和非预期后果。
The intended and unintended consequences of clinical guidelines.
机构信息
New England Research Institutes, Watertown, Massachusetts, USA.
出版信息
J Eval Clin Pract. 2009 Dec;15(6):1035-42. doi: 10.1111/j.1365-2753.2009.01201.x.
OBJECTIVES
First, we examine whether clinical guidelines, designed to improve health care and reduce disparities in clinical practice, are achieving their intended consequences. Second, we contemplate potential unintended consequences of clinical guidelines.
METHOD
As part of a factorial experiment we presented primary care doctors (n = 192) with clinically authentic vignettes of a 'patient' with already diagnosed diabetes with an emerging foot neuropathy. Their proposed clinical actions were compared with established practice guidelines for this clinical situation.
RESULTS
After establishing the existence of consistent socioeconomic disparities in the proposed management of the case presented, we found that reported use of practice guidelines had no measurable effect towards their reduction (one intended consequence). However, the reported use of practice guidelines appeared to precipitate more clinical actions, without eliminating documented disparities.
CONCLUSIONS
Consistent with other research we find that clinical practice guidelines are not producing a principal intended result, and may even produce unintended consequences.
目的
首先，我们研究旨在改善医疗保健并减少临床实践差异的临床指南是否正在实现其预期结果。其次，我们思考临床指南可能产生的意外后果。
方法
作为一项析因实验的一部分，我们向初级保健医生（n=192）提供了已确诊糖尿病患者出现新发足部神经病变的“患者”的临床真实病例。将他们提出的临床措施与该临床情况的既定实践指南进行了比较。
结果
在确定提出的病例管理中存在一致的社会经济差异后，我们发现报告的实践指南的使用并没有对其减少（一个预期结果）产生可衡量的效果。然而，报告的实践指南的使用似乎促使了更多的临床行动，而没有消除记录的差异。
结论
与其他研究一致，我们发现临床实践指南没有产生主要预期结果，甚至可能产生意外后果。
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